Juris B DME MAC Claim Payment Alert - Claims Processed with Incorrect MUE Values
Message from CGS Provider Outreach
CGS is aware of a claim processing issue which has caused a number of claims to be processed incorrectly, denying with Reason Code CO-151, due to an issue with the Medically Unlikely Edit (MUE) files. We recently became aware that in addition to the impact to initial claims, there is also an impact to claim adjustments that were initiated or in process on 9/23/20 or 9/24/20.
These adjustments may have been the result of a re-openings request, appeals request, CARES Act adjustment, or any other reason that a claim would normally be adjusted. The affected adjustments have also denied with Reason Code CO-151. In the case of many of these adjustments, because the initial claim had been paid, the now denied adjustment has automatically created an overpayment situation. You may incorrectly receive overpayment demand letters or immediate offsets regarding these claims. Note that not all CO-151 denials were processed incorrectly.
CGS is working on a solution to resolve this issue as quickly as possible, although we cannot currently provide a timeframe for when all of the claims and adjustments will be corrected. At this time, you do not need to take any action regarding the affected claims, adjustments, or overpayments.
Please continue to monitor our ListServ and our Claim Payment Alerts page for additional information, which we will provide as soon as it is available.